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前交叉韧带重建术联合或不联合外侧束固定术或前外侧韧带重建术的短期疗效:回顾性队列研究。

Short-term outcomes of anterior cruciate ligament reconstruction with or without lateral tenodesis or anterolateral ligament reconstruction: a retrospective cohort.

机构信息

Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar.

Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.

出版信息

Int Orthop. 2023 Dec;47(12):2991-2999. doi: 10.1007/s00264-023-05931-6. Epub 2023 Aug 26.

Abstract

PURPOSE

This study aimed to compare the short-term outcomes of ACL reconstruction (ACLR) alone, ACLR with lateral tenodesis, and ACL and ALL reconstruction.

METHODS

A retrospective cohort of prospectively collected data on all ACL procedures was performed at Aspetar Specialized Orthopaedic and Sports Medicine Hospital between January 2020 and January 2021. Patients were treated with ACLR alone, ACLR with lateral tenodesis, or ACLR with ALL reconstruction. The primary outcome was the subjective International Knee Documentation Committee (sIKDC) score. The secondary outcomes were the ACL Return to Sport after Injury (ACL-RSI) scores, pivot shift grade, subjective knee stability, and subjective pain on activity.

RESULTS

A total of 100 cases were included. The most common technique was ACLR with lateral tenodesis (42%), followed by ACLR alone (38%) and ACL with ALL reconstruction (20%). The mean age was 28.15 years (15-60), and 94% of the patients were males. Meniscal procedures were more frequent in the ACLR alone group (65.8%). There was no association between subjective stability, sIKDC, ACL-RSI, and pivot shift grade and the three ACLR techniques while adjusting for age, sex, and concomitant meniscus procedures at six weeks, 12 weeks, six months, and nine months. However, there was a significant decrease in postoperative flexion in the ACL and ALL reconstruction group by a mean of 22° (95% CI - 40.7 - 3.4; P = 0.02) at 6 weeks compared to ACLR alone, which was not evident on later follow-ups.

CONCLUSION

ACLR with/without lateral augmentation procedures yields similar subjective IKDC, ACL-RSI, pivot shift grade, and subjective knee instability at short-term follow-up. Therefore, lateral extra-articular augmentation procedures are safe to be performed.

摘要

目的

本研究旨在比较单独前交叉韧带重建(ACLR)、ACL 联合外侧束固定术和 ACL 与 ALL 重建的短期结果。

方法

对 2020 年 1 月至 2021 年 1 月在 Aspetar 专科医院进行的所有 ACL 手术的前瞻性数据进行回顾性队列研究。患者接受单独 ACLR、ACL 联合外侧束固定术或 ACL 与 ALL 重建术治疗。主要结果是国际膝关节文献委员会(IKDC)主观评分(sIKDC)。次要结果包括 ACL 损伤后重返运动评分(ACL-RSI)、膝关节旋转试验分级、膝关节主观稳定性和活动时主观疼痛。

结果

共纳入 100 例患者。最常见的手术技术是 ACL 联合外侧束固定术(42%),其次是单独 ACLR(38%)和 ACL 与 ALL 重建术(20%)。平均年龄为 28.15 岁(15-60 岁),94%的患者为男性。单独 ACLR 组更常进行半月板手术(65.8%)。在调整年龄、性别和同期半月板手术的情况下,术后 6 周、12 周、6 个月和 9 个月,膝关节主观稳定性、sIKDC、ACL-RSI 和膝关节旋转试验分级与三种 ACLR 技术之间均无关联。然而,与单独 ACLR 相比,ACL 与 ALL 重建组术后膝关节屈曲度平均减少 22°(95%可信区间-40.7°至-3.4°;P=0.02),这一现象在后期随访中并未出现。

结论

ACL 联合或不联合外侧加固术在短期随访中,在主观 IKDC、ACL-RSI、膝关节旋转试验分级和膝关节主观不稳定方面具有相似的结果。因此,外侧关节外加固术是安全的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db5e/10673961/f49c0fdc391e/264_2023_5931_Fig1_HTML.jpg

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